Динамика объема функционирующей паренхимы и раздельной почечной функции до и после резекции почки по поводу опухоли

Abstract

Objective. To assess functions of each kidney in dynamics using mathematical analysis of contrast-enhanced computed tomography findings in patients with unilateral kidney tumors. Patients and methods. We present preliminary results of a prospective study within the protocol "Assessment of the functioning renal parenchyma volume and functions of each kidney in patients with tumors before and after resection" conducted in the Institute of Urology and Human Reproductive Health, I.M.Sechenov First Moscow State Medical University. This study included 20 patients of both sexes who had undergone resection of unilateral kidney tumors with compression of the main renal artery. We performed mathematical analysis of contrast-enhanced computed tomography findings before surgery and 3–6 months postoperatively to evaluate functions of each kidney. In addition to that, we measured the dynamics of total glomerular filtration rate (GFR) using a special formula. Results. We observed no significant dynamics in any total functional renal parameters (creatinine level, total GFR, total functioning renal parenchymal volume) and in 3D-GFR of each kidney. However, there were significant differences in the dynamics of functional parameters measured for each kidney individually, including 3D renal perfusion and functioning parenchyma volume of each kidney. The volume of functioning renal parenchyma in the affected kidney decreased significantly (p = 0.006). In the subgroup with no lesions, we observed no significant dynamics (p = 0.236). Changes in perfusion affected both sides. Conclusion. We found no significant changes in the total kidney function after surgery, which suggests a sufficient reserve capacity of this paired organ. Increased postoperative perfusion in the intact kidney is likely to reflect redistribution of functional loads between the kidneys and can be considered as an adaptive mechanism. This hypothesis is also confirmed by redistribution of the functioning parenchyma volume 3–6 months postoperatively. The intact kidney probably compensates the loss of function in the affected kidney.